Premature neonates often receive oral sucrose or dextrose before tissue-damaging procedures (TDPs... more Premature neonates often receive oral sucrose or dextrose before tissue-damaging procedures (TDPs). Previous work showed that a single dose of sucrose, but not dextrose, increased cellular energy utilization and ATP degradation. This pilot study probes the effects of repeated administration of sucrose or dextrose on energy metabolism. Urinary markers of ATP metabolism (hypoxanthine, xanthine, uric acid) are measured in premature neonates randomized to receive: (a) standard of care, (b) 0.2 ml 24% oral sucrose, or (c) 0.2 ml 30% oral dextrose, before every painful procedure on days-of-life 3–7. Standard of care is associated with highest xanthine/creatinine and uric acid/creatinine, likely because of fewer pain treatments. Benefits of repeated oral sucrose are unclear. Neonates receiving oral dextrose had lower xanthine/creatinine and uric acid/creatinine. Repeated treatments of neonatal procedural pain with 30% oral dextrose are less energetically demanding. Larger clinical studies are needed for comparison with sucrose treatments.
A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extrem... more A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extremities (Figs 1 and 2) presents to the emergency department after transport from the birth hospital. Figure 1. Hemihypertrophy of infant’s right side. Figure 2. Port-wine stain on forehead and alae of nose with cutis marmorata telangiectasia on the arms and trunk. ### Prenatal and Birth Histories ### Birth History
A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extrem... more A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extremities (Figs 1 and 2) presents to the emergency department after transport from the birth hospital. Figure 1. Hemihypertrophy of infant’s right side. Figure 2. Port-wine stain on forehead and alae of nose with cutis marmorata telangiectasia on the arms and trunk. ### Prenatal and Birth Histories ### Birth History
Journal of applied physiology (Bethesda, Md. : 1985), 1985
We have designed a new endotracheal flowmeter to measure tidal volume, phasic and mean airway pre... more We have designed a new endotracheal flowmeter to measure tidal volume, phasic and mean airway pressures, inspiratory time, and end-tidal PCO2 and PO2 in intubated infants. The flowmeter is light (11 g) and adds minimal dead space (1.0 ml) and resistance (2 cmH2O X 100 ml- X s) to the infant's airway. The volume signal (less than or equal to 10 ml) is linear to 7 Hz, and end-tidal gases can be measured at respiratory rates of 90 breaths/min. This flowmeter is particularly valuable for evaluation of rapid mechanical ventilation of very low birth weight infants.
We evaluated late survival among pediatric heart transplant patients who have lived more than 15 ... more We evaluated late survival among pediatric heart transplant patients who have lived more than 15 years. This is a retrospective chart review of the pediatric patients who underwent heart transplantation (HTx) between 1985 and 1998. Multivariate and univariate analyses were examined. There were 183 recipients, of whom 151 are currently alive. Age at HTx ranged from 0 days to 17.48 years (median 56 days). Pretransplant diagnoses included congenital heart disease 142 (77.6%), cardiomyopathy 38 (20.8%), and tumor 3 (1.6%). Pretransplant renal dysfunction was present in 58 patients (31.7%). Perioperative peritoneal dialysis was instituted in 15 patients, all recovered. During the follow-up period (median 20.2 years), 17 (9.3%) have had renal transplants, and 2 require hemodialysis. There were 32 deaths from the following: cardiac allograft vasculopathy (CAV); 11 (34.3%); posttransplant lymphoproliferative disease 6 (18.8%); acute rejection 4 (12.5%); sepsis 2 (6.3%); multiorgan failure 1 (3.1%); and unknown 8 (25%). Immunosuppressive therapy for the living patients consists of monotherapy 25 (17.7%), dual therapy 87 (61.7%), triple therapy 24 (17%), quadruple therapy 5 (3.5%), and 10 unknown. Cardiac re-Tx was required for CAV in 30 patients and for graft failure in 6 patients. Four patients required a third transplant for CAV. For those who survived more than 15 years after HTx, actuarial survival to 20 years and 25 years is 82% and 78%, respectively. Pediatric HTx provides acceptable long-term survival. Cardiac re-Tx and renal transplantation offer reasonable palliation for recipients who develop CAV and renal dysfunction.
Premature neonates often receive oral sucrose or dextrose before tissue-damaging procedures (TDPs... more Premature neonates often receive oral sucrose or dextrose before tissue-damaging procedures (TDPs). Previous work showed that a single dose of sucrose, but not dextrose, increased cellular energy utilization and ATP degradation. This pilot study probes the effects of repeated administration of sucrose or dextrose on energy metabolism. Urinary markers of ATP metabolism (hypoxanthine, xanthine, uric acid) are measured in premature neonates randomized to receive: (a) standard of care, (b) 0.2 ml 24% oral sucrose, or (c) 0.2 ml 30% oral dextrose, before every painful procedure on days-of-life 3–7. Standard of care is associated with highest xanthine/creatinine and uric acid/creatinine, likely because of fewer pain treatments. Benefits of repeated oral sucrose are unclear. Neonates receiving oral dextrose had lower xanthine/creatinine and uric acid/creatinine. Repeated treatments of neonatal procedural pain with 30% oral dextrose are less energetically demanding. Larger clinical studies are needed for comparison with sucrose treatments.
A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extrem... more A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extremities (Figs 1 and 2) presents to the emergency department after transport from the birth hospital. Figure 1. Hemihypertrophy of infant’s right side. Figure 2. Port-wine stain on forehead and alae of nose with cutis marmorata telangiectasia on the arms and trunk. ### Prenatal and Birth Histories ### Birth History
A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extrem... more A newborn at 375/7 weeks’ gestation with multiple port-wine stains on the face, trunk, and extremities (Figs 1 and 2) presents to the emergency department after transport from the birth hospital. Figure 1. Hemihypertrophy of infant’s right side. Figure 2. Port-wine stain on forehead and alae of nose with cutis marmorata telangiectasia on the arms and trunk. ### Prenatal and Birth Histories ### Birth History
Journal of applied physiology (Bethesda, Md. : 1985), 1985
We have designed a new endotracheal flowmeter to measure tidal volume, phasic and mean airway pre... more We have designed a new endotracheal flowmeter to measure tidal volume, phasic and mean airway pressures, inspiratory time, and end-tidal PCO2 and PO2 in intubated infants. The flowmeter is light (11 g) and adds minimal dead space (1.0 ml) and resistance (2 cmH2O X 100 ml- X s) to the infant's airway. The volume signal (less than or equal to 10 ml) is linear to 7 Hz, and end-tidal gases can be measured at respiratory rates of 90 breaths/min. This flowmeter is particularly valuable for evaluation of rapid mechanical ventilation of very low birth weight infants.
We evaluated late survival among pediatric heart transplant patients who have lived more than 15 ... more We evaluated late survival among pediatric heart transplant patients who have lived more than 15 years. This is a retrospective chart review of the pediatric patients who underwent heart transplantation (HTx) between 1985 and 1998. Multivariate and univariate analyses were examined. There were 183 recipients, of whom 151 are currently alive. Age at HTx ranged from 0 days to 17.48 years (median 56 days). Pretransplant diagnoses included congenital heart disease 142 (77.6%), cardiomyopathy 38 (20.8%), and tumor 3 (1.6%). Pretransplant renal dysfunction was present in 58 patients (31.7%). Perioperative peritoneal dialysis was instituted in 15 patients, all recovered. During the follow-up period (median 20.2 years), 17 (9.3%) have had renal transplants, and 2 require hemodialysis. There were 32 deaths from the following: cardiac allograft vasculopathy (CAV); 11 (34.3%); posttransplant lymphoproliferative disease 6 (18.8%); acute rejection 4 (12.5%); sepsis 2 (6.3%); multiorgan failure 1 (3.1%); and unknown 8 (25%). Immunosuppressive therapy for the living patients consists of monotherapy 25 (17.7%), dual therapy 87 (61.7%), triple therapy 24 (17%), quadruple therapy 5 (3.5%), and 10 unknown. Cardiac re-Tx was required for CAV in 30 patients and for graft failure in 6 patients. Four patients required a third transplant for CAV. For those who survived more than 15 years after HTx, actuarial survival to 20 years and 25 years is 82% and 78%, respectively. Pediatric HTx provides acceptable long-term survival. Cardiac re-Tx and renal transplantation offer reasonable palliation for recipients who develop CAV and renal dysfunction.
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